Healthcare Provider Details

I. General information

NPI: 1619250131
Provider Name (Legal Business Name): QIYU HUANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 DIXIE HWY
LOUISVILLE KY
40210-1745
US

IV. Provider business mailing address

4001 SARATOGA WOODS DR
LOUISVILLE KY
40299-4357
US

V. Phone/Fax

Practice location:
  • Phone: 502-772-1822
  • Fax:
Mailing address:
  • Phone: 502-290-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007138
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA130173
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: